Complete MPFL Rupture: Treatment Options and Recovery

Complete rupture of the medial patellofemoral ligament (MPFL) from the patella in the left

Hello doctor, on November 7th, I bumped into a chair and dislocated my patella.
The emergency physician performed a manual reduction of the knee dislocation.
The next day, an orthopedic doctor at Mackay Memorial Hospital removed the cast and drained the blood accumulation from my knee.
I have been seeing orthopedic doctors at Mackay, and they have not indicated any significant abnormalities, only noting that I have patellar malalignment.
Later, my physical therapist suggested I undergo an ultrasound examination because there was a significant temperature difference between my knees and noticeable swelling, and it had already been a month.
After that, I went to a clinic for an ultrasound, and the doctor there said I had a ligament tear but that it was not a concern.
However, on December 19th, I had a musculoskeletal ultrasound at Mackay, and the doctor informed me that the dislocation had caused a complete rupture of my ligament (the medical record states: Sonar Diagnosis left knee MPFL complete rupture from patella).
Since there has been no improvement to date, surgery for ligament reconstruction has been recommended.
Although I do not doubt the doctor who performed the ultrasound, I feel uneasy about the idea of surgery, especially since I have a significant drug allergy (I have undergone drug testing at Chang Gung Memorial Hospital) and would prefer to avoid surgery.

1.
If the MPFL is torn, is there still a chance for spontaneous recovery? (It has been nearly six weeks, and there is still swelling.)
2.
What is the concept of the surgery? What would happen if I do not proceed with it?
3.
Should I seek opinions from more doctors? (Because not many doctors perform musculoskeletal ultrasounds, and those who do have indicated that my ligament is injured.)
4.
What movements should I avoid right now?
5.
Is it normal for my knee to start hurting after the musculoskeletal ultrasound?
6.
What actions can I take to minimize knee pain?

Niming, 10~19 year old female. Ask Date: 2018/12/21

Dr. Li Yongheng reply Orthopedics

Hello,
1.
The Medial Patellofemoral Ligament (MPFL) is typically injured due to traumatic patellar dislocation.
It is generally recommended to use a knee brace for stabilization and to limit flexion for at least six weeks.
Most patients will experience spontaneous recovery of the torn ligament due to appropriate immobilization.

2.
In cases of recurrent patellar dislocation, arthroscopic knee surgery is recommended.
This includes lateral retinacular release combined with medial patellofemoral ligament reconstruction.
If multiple episodes of recurrent patellar dislocation occur without treatment, it can lead to cartilage wear between the patella and femur, resulting in post-traumatic arthritis.

3.
You should undergo an MRI examination.

4.
Avoid excessive knee flexion, such as squatting and kneeling.

5.
This is normal.

6.
Currently, it is still advisable to avoid excessive movements, continue icing, and use a knee brace for stabilization.
If dislocation does not recur, surgical intervention is not yet considered.

Reply Date: 2018/12/21

More Info

Understanding a complete medial patellofemoral ligament (MPFL) rupture is crucial for determining the appropriate treatment options and recovery strategies. The MPFL plays a vital role in stabilizing the patella (kneecap) and preventing it from dislocating laterally. A complete rupture can lead to recurrent dislocations and instability in the knee, which can significantly affect mobility and quality of life.

1. Self-Healing Potential: Unfortunately, a complete rupture of the MPFL is unlikely to heal on its own. Ligaments have a limited blood supply, which hampers their ability to heal without surgical intervention. While some partial tears may heal with conservative treatment, a complete rupture typically requires surgical reconstruction to restore stability to the knee.

2. Surgical Concept: The primary goal of surgery for a complete MPFL rupture is to reconstruct the ligament to restore its function. This is usually done through a minimally invasive procedure where the surgeon uses graft tissue (which can be taken from the patient or a donor) to replace the torn ligament. If surgery is not performed, the patient may continue to experience instability, recurrent dislocations, and potentially develop secondary issues such as osteoarthritis due to abnormal joint mechanics.

3. Seeking Multiple Opinions: It is always advisable to seek multiple medical opinions, especially when facing a significant decision like surgery. Different orthopedic surgeons may have varying experiences and approaches to treating MPFL injuries. Consulting with specialists who have expertise in sports medicine or knee injuries can provide additional insights and help you make an informed decision.

4. Avoiding Certain Movements: To prevent further injury and manage symptoms, it is essential to avoid activities that place stress on the knee, such as squatting, jumping, or any high-impact sports. Additionally, movements that involve twisting or pivoting should be minimized until the knee has stabilized.

5. Post-Ultrasound Pain: Experiencing pain after a musculoskeletal ultrasound is not uncommon. The procedure can cause temporary discomfort, especially if the area is already inflamed or injured. However, if the pain persists or worsens, it is essential to follow up with your healthcare provider.

6. Pain Management Strategies: To alleviate knee pain, consider the following strategies:
- Rest and Ice: Allow the knee to rest and apply ice to reduce swelling and pain.

- Compression and Elevation: Use a compression wrap and elevate the leg to minimize swelling.

- Gentle Range of Motion Exercises: Engage in gentle stretching and range of motion exercises as tolerated to maintain flexibility without exacerbating pain.

- Physical Therapy: A physical therapist can design a rehabilitation program tailored to your needs, focusing on strengthening the muscles around the knee and improving stability.

In summary, a complete MPFL rupture typically does not heal on its own and often requires surgical intervention for optimal recovery. Seeking multiple medical opinions is wise, and avoiding certain movements can help manage symptoms. If you have concerns about pain or treatment options, it is essential to communicate openly with your healthcare providers to ensure the best possible outcome for your knee health.

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